Wednesday, September 26, 2018 1:00 PM – 2:00 PM Interventional Pain Management: 33. Improving spinal fusion patient-reported outcomes with a single preoperative education session

Abstract

BACKGROUND CONTEXT Patient expectations have been demonstrated to influence recovery following spine surgery. Addressing patient expectations specifically in regards to pain and postsurgical healing is an important factor in improving patient's recovery patterns. Presurgical education can potentially help manage patient expectations. PURPOSE The primary objective was to determine if participation in a single preoperative multidisciplinary educational session would result in reduced patient dissatisfaction with surgical expectations. A secondary objective investigated if participation resulted in improvements in postsurgical pain and disability. STUDY DESIGN/SETTING A retrospective cohort study using Canadian Spine Outcomes and Research Network (CSORN) data. PATIENT SAMPLE Participants were patients receiving elective spinal fusion for 2-5 levels (N=206). Cohort 1: patients who participated in preoperative multidisciplinary education (n=103). Cohort 2: patients who opted-out of the educational session (n=103). OUTCOME MEASURES Outcome measures included the Oswestry Disability Index (ODI), NRS Scales for back and leg pain (NRS-B/L), CSORN questions pertaining to the patient's satisfaction with surgery and whether the surgery met a variety of their expectations. METHODS Spinal fusion patients are encouraged to attend a one-time, two-hour education session 3-6 weeks prior to surgery. The education session includes interactive discussions with nursing, physiotherapy and occupational therapy staff concentrating on what patients should expect, how to best prepare for surgery and proper care after surgery. Baseline analysis was conducted to ensure cohorts did not significantly differ in any way outside of attendance to the education session. Outcome measures of interest were collected at 12 weeks postoperatively. Continuous variables were compared with ANOVA, and categorical variables with chi-square analysis. Significance was set at α RESULTS Patients who took part in the presurgical education sessions were significantly more satisfied with their surgery compared to the control cohort (p=0.014). Patients who did not participate in the education session failed to have their expectations met in terms of improvement in daily activities (p=.03), improvement in walking capacity (p=.03), and their expectation of back pain reduction (p=001). There was a statistically significant effect of participation in the educational session reducing postoperative back pain (p=.03), though this improvement did not reach clinically significant levels. CONCLUSIONS Participation in a single 2-hour educational session prior to surgery positively impacted patient satisfaction, expectations and back pain. Use of a low administrative burden, single education session is a viable tool for improving patient outcomes. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.